Impact of different modes of mechanical ventilation on kidney and liver functions

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Abstract

Background

Preclinical and clinical studies suggest that mechanical ventilation contributes to alterations in distant organ function, particularly in the setting of lung-injurious ventilator strategies.

Aim

Our goal was to determine the effect of mechanical ventilation with different modes [synchronized intermittent mandatory ventilation (SIMV), continuous positive airway pressure (CPAP), and biphasic intermittent positive airway pressure (BIPAP)] on renal and hepatic functions.

Method

This study was a single-blinded controlled study that included 60 patients and was carried out at Al-Zahraa and Al-Hossein University Hospitals with the aim of comparing different modes of mechanical ventilation in critically ill patients with acute lung injury at randomization. During the first 7 days of mechanical ventilation, the levels of traditional acute kidney injury markers, namely, serum creatinine, urea, creatinine clearance, and urine output (UOP) were determined daily and liver functions tests including liver enzymes (serum glutamic-oxalocetic transaminase, serum glutamic-pyruvic transaminase and alkaline phosphatase) were performed daily.

Results

The SIMV and CPAP modes showed a marked and significant impairment in both hepatic and renal function in the form of significant elevation in the levels of liver enzymes (serum glutamic-oxalocetic transaminase, serum glutamic-pyruvic transaminase and alkaline phosphatase) and a significant decrease in the level of renal markers (creatinine clearance and UOP). However, the BIPAP mode did not show a significant effect on both hepatic and renal functions.

Conclusion

In the present study involving critically patients with acute lung injury at the onset of mechanical ventilation, BIPAP mode ventilation reduced the development of acute kidney injury and liver injury compared with the SIMV and CPAP modes.

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